临床与咨询心理学导论 11 - The Clinical Interview

L11 The Clinical Interview 

参考文献：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

11.1 Clinical Interview Skills & Behaviors

Clinical Interviewing Skills

• Quieting yourself - not just stop speaking

- Reduce internal, self-directed thinking pattern

- Don’t be distracted by your unrelated thoughts

• Being self-aware

- Consider your interpersonal impact on others

- Be aware of your own traits and how others usually respond to them

• Developing a positive working relationship

- Interviews often happen at the start of treatment

- Attention, empathy, respect, and cultural sensitivity can be helpful

Clinical Interviewing Behaviors

Eye Contact; Vocal Qualities; Body Language & Posture; Verbal Tracking; Name Use; Making Behavioral; Observations, etc.

11.2 Components of the Interview

11.2.1 Rapport

Positive, comfortable relationship between client and interviewer

Allows client to feel safe and understood

• Built through:

Putting a client at ease (eg chatting, SMall talks)

Acknowledging the challenges of the interview dynamic

Matching the client’s terminology, metaphors, etc. (verbal tracking)

11.2.2 Techniques

• Directive Style (Close-ended questions, short)

Ask specific, direct questions (“When did your depression start?”)

Pro: May get pertinent information efficiently

Con: May not give client opportunity to volunteer important information

• Nondirective Style (Open-ended questions, long)

Allow client to determine course of interview

Pro: May be better for building rapport

Con: May miss important information because it did not come up

- Interviewer Responses

• Clarification

Questions that ensure that a psychologist understands what the client is saying

Helps the client see that the psychologist is listening

Example: “I want to make sure I understand this correctly…”

• Confrontation (not aggressive)

Similar to clarification but with a focus on inconsistencies

Point out the conflicting information and try to resolve discrepancies

• Paraphrasing

Comments to ensure the client that they are being heard

Reflects the client’s words

• Reflecting feelings

Comments to recognize the client’s emotions

• Summarizing

Tying together different topics that have been discussed

Connecting statements made at different points

11.2.3 Conclusions

At the end of the interview

Differ for different types of interviews, the client’s specific problems, and the setting

Can include: More Detailed Summarizing; Specific Diagnosis; Recommendations for Specific Treatment; Recommendations for AssesSMent, etc.

11.3 Specific Types of Interviews

11.3.1 Intake Interviews

• Interviews to determine if the client needs treatment and whether the current facility can provide that treatment - If not, enough information is obtained to determine what setting would be appropriate (e.g., inpatient hospitalization, intensive outpatient program)

• Primary focus on the presenting problem:

- Main reason for seeking out treatment

- Details of the current problem(s)

- Mental health and treatment history

11.3.2 Diagnostic Interviews

• Interviews focused specifically on determining the presence of mental disorders

- Specific diagnoses

- Problem definition

- Case formulation

- Goal specification

• Vary from very unstructured to very structured

Types of Diagnostic Interviews

• Unstructured: No standard set of questions or structured method for integrating and summarizing obtained information

Psychologist decides:

- What topics to cover

- Screening questions

- Follow-up probes

- Rating system used for symptoms

- Means of determining diagnosis (criteria vs. impressions)

• Structured: Very specific format for asking questions, determining followups, integrating and summarizing obtained information - planned before interview happens

- Tied to particular sets of criteria such as DSM-5

- A manual specifies instructions:

• What questions to ask

• What order to ask them

• How to ask them

• How to follow them up

• How to interpret answers

- Strongest reliability & validity

- Long interview, less flexibility

• Structured Clinical Interview for DSM-5 (SCID)

- Gold standard structured diagnostic instrument

- Most disorders included (separate version for personality disorders)

- Modular approach - reduce time

- Training and supervision usually extensive

• Semi-Structured

- Blend of structured and unstructured approaches

- Provides:

• Areas that need to be covered

• Standard for rating symptoms

• Sometimes: “starter” questions

- Flexibility (may not provide):

• Follow-up questions/probes

• Exact wording for all questions

11.3.3 Mental Status Exams

• Brief assesSMent of psychological and cognitive functioning at the time of evaluation - quick, not detailed or comprehensive for diagnosis

• Involves direct questioning and the examiner’s observations

• Used primarily in medical settings

• Not focus on personal history, background, or the presence of specific DSM symptoms; instead focus on:

- Appearance

- Behavior & psychomotor activity

- Attitude towards examiner

- Affect and mood

- Speech and thought

- Perceptual disturbances

- Orientation to person, place, and time

- Memory and intelligence

- Reliability, judgment, and insight

11.3.4 Crisis Interviews

Address urgent problems and provide some immediate intervention.

• Suicide risk assesSMent

- Suicidal Ideation: Are you thinking about killing yourself?

- Suicide Plan: Have you thought of ways you might hurt yourself? Do you have pills/weapons in your house?

- Suicide Intent: saying goodbye, make plans for friends...

- Risk and protective factors

IS PATH WARM

Ideation - Threatened or communicated

Substance abuse - Excessive or increased

Purposeless - No reasons for living

Anxiety - Agitation / Insomnia

Trapped - Feeling there is no way out

Hopelessness

Withdrawing - from friends, family, society

Anger (uncontrolled) - Rage, seeking revenge

Recklessness - Risky acts, unthinking

Mood change (dramatic)

• Safety planning - unique for each client

- Develop individualized plan to help client:

• Recognize warning signs

• Identify and use coping strategies

• Use social support

• Contact professional help

- Safety contracts or treatment commitments sometimes developed and used in these situations: calling 911, making promises not to self-harm, etc.